A patient with depressed immunity may experience an increase in melanocytic lesions and the risk for malignant melanoma.
Patients at risk:
(1) organ transplantation, especially renal transplantation
(2) scleroderma or dermatomyositis treated with immunosuppressants
(3) cancer chemotherapy
where:
• The impact of cancer chemotherapy has been seen in children, possibly because of a longer survival.
Drugs associated with an increased risk:
(1) cyclosporin A
(2) azathioprine
These patients may also experience visceral melanomas (esophagus, other sites).
Recommendations:
(1) Monitor pigmented skin lesions in patients at risk.
(2) Recommend maximum protection against sun or other light exposures.
If the patient does develop a malignant melanoma, then it may behave more aggressively if there is ongoing immunosuppression. This can lead to the difficult situation of deciding which hazard is greater - tumor progression or worsening of the underlying disease (being controlled by the immunosuppression).
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